3a diseases headlines Flashcards
Bishop Scoring
Rates the favourability of the cervix (10 is good). Based on dilatation, position in vagina, effacement
Partogram
Measures progress in labour.
- dilatation of cervix
- vital signs
- liquor colour
- Fetal heart rate
Cardiotocography
Measures FHR and uterine contactions (you expect variability and accelerations), FHR 110-160, no decelerations. Not useful antenatally unless daily in high risk
Fetal scalp samples
Amnioscope to get blood sample. pH below 7.2 needs delivery as acidotic and hypoxic
Amniocentesis
Fine gauge needle and US. (15 weeks) Chromosomal abnormalities, CMV and toxoplasmosis, Sickle cell, CF and Thallasaemia. 1% miscarry
Chorionic villus sampling
Biopsy of trophoblast. (11 weeks (quicker)) Higher miscarriage rates than amniocentesis. PCR and FISH for results.
Sperm sample boundaries of viability
5-15 million/mL=oligospermia
<32% motile= asthenospermia
Causes of male subfertility
Idiopathic Drug exposure (alcohol, smoking, steroids) Varicocele Antisperm antibodies Infections Kleinfelters CF Kallmans TURP
APGAR score
HR RR Muscle tone Colour Reflex /10. At 1 and 5mins. Resuscitation? Neuro outcome?
Assisted conception
Intrauterine insemination (IUI) if mild sperm problems. Intracytoplasmic sperm injection (ICSI) if severe.
IVF -mulitple follicular development -ovulation and egg collection -fertilisation and culture -embryo transfer. Multiple pregnancy and ovary overstimulation risks
Combined oral contraceptives
Exert negative feedback on gonadotrophin release, inhibiting ovulation. Thin endometrium and thicken cervical plug. Withdrawal bleeds if 1 week break, if not then spotting
Progesterone side effects
Depression Bleeding Amenorrhoea Acne Breast discomfort Weight gain Reduced libido
Oestrogen side effects
Nausea Headaches Increased mucus Fluid retention and weight gain Breast tenderness and fullness Bleeding
Hormonal contraceptive negatives
Major complications (venous thrombosis, venous thromboembolism, migraine, stroke) Minor side effects
Depoprovera
IM injection every 3 months, reduced bone density. Progesterone
Emergency contraception
IUD
Morning after pill
Barrier contraceptives
Male condom Female condom Diaphragms Caps Spermicides
What is the difference between IUDs and IUSs
IUD copper- toxic to sperm
IUS(system)- mirena (progestogen) hormonal.
General advantages and disadvantages
User dependence
Complications
Contraceptive
Protects from STIs
Other contraceptives
Male and female sterilisation
Pneumonia
Fever, tachypnoea, malaise, RDS.
CXR, O2 sats
Amoxicillin
Pneumococcus, mycoplasma, haemophilus, staphylococcus, TB, viral
Croup
Viral laryngotracheobronchitis
6 months to 6 years (2yo)
Upper airway obstruction (=stridor, barking cough, hoarse)
Pred
Epiglottitis
Caused by H. influenza B so went down cos of vaccine. Very acute, no preceding symptoms. Silent. Cant drink. Drooling. Soft stridor
Asthma
Inflammation, hyperresponsiveness, narrowing
Wheeze, cough, breathless, chest tight
Worse at night, triggers, symptoms between exacerbations
Peak flow diary, sleep? exercise?
Salbutamol (ipratropium bromide if young)
Salmeterol
Refer
Viral induced wheeze
Increased risk in preterm and maternal smoking, Small airways more likely to narrow and obstruct due to inflammation. Resolves by 5
Bronchiolitis
1-9 months Poor feeding, apnoea, dry cough, laboured breathing Respiratory syncytial virus PCR analysis of nasal secretions Supportive: humidified oxygen
Cystic fibrosis
CTFR chromosome 7
Meconium ileus, pancreatic enzyme deficiency, malabsorption, atypical pneumonia
Hyperinflation, nasal polyp, sinusitis, failure to thrive
Sweat test 60-125
MDT
Physio, Dornase Alpha, pancreatic enzymes, high calorie diet, ICSI
Otitis media
6-12 months
Eustachian tubes short, horizontal and dont work
Examine tympanic membrane in all fever infants (bright red, bulging)
RSV, rhinovirus, pneumococcus
Regular anaesthesia
(can lead to with effusion, glue ear)
Grommets
Tympanostomy tubes, for ottitis media with effusion. Adenoidectomy can be more effective
Glue ear
2-7 years old
Caused by recurrent ear infections
Decreased hearing
Ear drum dull and retracted with fluid level
Flat trace on tympanometry
Conductive hearing loss, speech and language problems.
Grommets and adenoidectomy
Sensorinueral Deafness
Genetic Injuries, hypoxia, infections More profound hearing loss Doesnt improve and may get worse Amplification or cochlear implant
Conductive hearing loss
Mainly glue ear Eustachian tube dysfunction (down syndrome, cleft palate) Wax Intermittent, not total, resolves Conservative, amplification or surgery
Periorbital cellulitis
Fever, erythema, tenderness of the eyelid
Prompt IV antibiotics
Prevent orbital cellulitis (CT scan, pain, proptosis)
Squint
Strabismus, misallignment of visual axis.
Corneal light reflex test and cover test
Glasses, surgery, patches
Septal defects
more than 3mm is big
Breathless, recurrent chest infections, endocarditis
CXR, ECG, Echo
Occlusion device, prostaglandin infusion
Heart failure
Poor feeding, sweating, tachypnoea, tachycardia, cardiomegaly, gallop, hepatomegaly
neonates=obstructed systemic circulation
infants=high pulmonary flow
older=eisenmenger, rheumatic, cardiomyopathy
Heart lung transplant, diuretics and ACE-I
cyanotic heart disease
Prostaglandin maintains duct patency CXR, ECG, Doppler echo Tetralogy of fallot Transposition of aorta ASD
Rheumatic fever
GABHS
Latent 2-6 weeks then
Pharyngeal infection, polyarthritis, mild fever and malaise
Can lead to pancarditis, involuntary movements and erythema marginatum
Bed rest and aspirin
Antistreptococcal antibodies if persisting
Arrythmias
SVT
Carotid sinus massage or ice pack to face
IV adenosine then electrical cardioversion if that fails
Long QT
Sudden LOC during exercise
Subacute bacterial endocarditis
Fever, anaemia, pallor, splinter haemorrhages, splenomegaly, necrotic skin lesions
Multiple blood cultures
Strep viridans
High dose penicillin and aminoglycoside IV for 6 weeks
GORD
Fluid diet, horizontal posture and short oesophageal length
History of vomiting and failure to thrive
No Ix needed but can do 24hr oesophageal pH test
Thickener to feeds and sit up after feeds
Pyloric stenosis
Projectile vomiting in first few weeks of life.
Visible gastric peristalsis, palpable mass on test feed. Ultrasound diagnosis
Surgery, rehydration and electrolyte correction
IBS
Abdo pain, relieved by defecation Explosive, loose or mucousy stools Bloating Feeling of incomplete defecation Constipation Family history, psychosocial factors
Gastroenteritis
Mostly viral or campylobacter, shigella or salmonella
dehydration
oral rehydration needed in most, IV in shock
Urinary stress incontinence
Involuntary leakage of urine on effort or exertion, coughing or sneezing.
Cystometry needed to confirm not overactive bladder.
Vaginal delivery risk factor
Lose weight and duloxetine
Hydratiform mole
Gestational trophoblastic disease
Extra proliferation of trophoblast, large uterus, BV bleeding, Snowstorm appearance on US
High serum hCG
Suction cuterrage to remove
Overactive bladder
Urgency with or without urge incontinence, usually with frequency or nocturia, in the absence of proven infection.
Urinary diary
Oestrogens, anticholinergics, botox
Uterovaginal prolapse
Descent of the uterus and or vaginal walls beyond normal anatomical confines
Graded 1-4 based on descent
Preg, vaginal delivery, obesity, cough, surgery
Pelvic floor exercises, better labour
Lose weight, treat cough. Pessaries. Hysterectomy. Surgery repair
Anterior uterovaginal prolapse
Cystourethrococoele
Posterior uterovaginal prolapse
Rectocele (rectum) or enterocele (pouch of douglas)
What type of prolapse do you get after hysterectomy
Vault prolapse
Genital tract fistula
Abnormal connection between urinary tract and other organs. Obstructed labour big cause worldwide. Surgery, radio n malignancy causes. Cystoscopy to prove. Surgery to fix
Ovarian cyst
Very painful if ruptures or haemorrhages. Intense pain with endometrioma or dermoid cyst. Urgent surgery
Ovarian torsion
Torsion of the pedicle, bulky due to cyst. Causes infarction of the ovary/ tube and severe pain. Urgent surgery and detorsion is required if the ovary is to be saved
Lichen sclerosis
Thin vulval epithelium, lost collagen. Severe pruritus, worse at night. Pink white papules. Thin skin. Inflammatory adhesions. Biopsy to exclude cancer. Treatment ultra potent steroids
Cervical cancer
90% squamous, also adenocarcinoma HPV= cervical intrapithelial neoplasia. Screening= liquid based cytology Biopsy Treatment= biopsy then trachelectomy then hysterectomy then radio/chemo
Endometrial cancer
Over 60s
90% adenocarcinoma, some adenosquamous
Pill and pregnancy protective (low oestrogen)
PMB
Hysterectomy and bilateral salpingoophrectomy
Ovarian cancer
90% Epithelial, germ cell if under 30
Abdominal distension,
Family history CA125
Late presentation. Hysterectomy. Debulk.
Vulval cancer
Vulval intraepithelial neoplasia, HPV and lichen sclerosis
Pruritis, bleeding, discharge mass
Biopsy
Wide local excision
Vaginal cancer
Often secondary. Can be primary squamous in older women. Intravaginal radiotherapy treatment.
Marasmus
Weight for height more than 3 standard deviations below median (70%), wasted, wizened appearance, apathetic (no oedema)
Kwashiokor
Generalised oedema, sparse and depigmented hair, skin rash, angular stomatitis, distended abdomen, enlarged liver, diarrhoea.
Hischprungs
No myenteric nerve plexus. Doesnt pass meconium in 48 hours, abdomen distends
Meckel diverticulum
Ileal remnant of vitello-intestinal duct. Rectal bleeding not red or melaena. Surgical resection
Wilson disease
Autosomal recessive, chromosome 13. Reduced caeruloplasmin and defective bile excretion= increased copper. Liver, brain, kidney, cornea. Liver biopsy, elevated hepatic copper.
Penicillamine, zinc, liver transplant
Henoch schlonein purpura
Skin rash (buttocks, arms and legs), arthralgia, periarticular oedema, abdo pain, glomerulonephritis. IgA and IgG complexes. NSAIDs
Alport syndrome
Familial nephritis. X linked recessive. Renal failure, males, deafness and ocular defects. Mother has haematuria.
Stephens Johnson syndrome
Severe bullous form of erythema multiforme, mucous membranes. Eye and mouth involvement. Drug sensitivity and infections can cause
Kawasakis disease
Prolonged fever. Conjunctivitis, cervical lymphadenopathy, polymorphous rash, cracked lips, strawberry tongue, oedema then peeling of hands and feet. Can lead to coronary artery aneurysms. IVIG. Aspirin
Kallman syndrome
Delayed or absent puberty and inability to spell. Hypogonadotrophic, hypogonadism. Hormone replacement.
Von willebrands disease
Quantitative or qualitiative deficiency of vwf. Defective platelet plugs.
Autosomal dominant
Brusing, excessive bleeding after surgery, mucosal bleeding (menorrhagia).
Mild= desmopressin
Severe= plasma derived F8
Wilms tumour
Renal tumour
Nephroblastoma, embryonal renal tissue.
Large abdominal mass (mets to lung). CT.
Chemo then nephrectomy
Kleinfelters syndrome
47, XXY Infertility Hypogonadism, small testes Pubertal development can be normal Gynaecomastia Tall stature Can have education and psych problems
Turners syndrome
45, X
Growth hormone therapy and oestrogen.
SHORT FEMALE
Lymphoedema of hands and feet, spoon shaped nails, thick neck. Wide carrying angly, wide nipples, coarctation of aorta, delayed puberty, ovary dysgenesis.
Down syndrome
Trisomy 21
Hypotonic, flat occiput, single palmar creases, incurved 5th finger, wide sandal gap.
Learning difficulty, hearing and vision problems
Risk of duodenal atresia and congenital heart disease
Rapid FISH blood tests
Meiotic non disjunction (maternal age), translocation and mosaicism cause
Edwards syndrome
Trisomy 18 Low birthweight Prominant occiput Small mouth and chin Short sternum Flexed overlapping fingers Rockerbottom feet Cardiac and renal malformations
Patau syndrome
Trisomy 13 Structural defect of brain Scalp defects Small eyes Cleft lip and palate Polydactyly Cardiac and renal malformations
Angelmans syndrome
Imprinting and uniparental disomy (dad).
Chromosome 15
Severe cognitive impairment
Facial appearance (prominent chin, deep set eyes, wide mouth)
Ataxia
Epilepsy
Prader Willi syndrome
Imprinting and uniparental disomy (mum) Chromosome 15 Hypotonia Developmental delay Hyperphagia Obesity
Noonan syndrome
Short webbed neck with trident hair line Pectus excavatum Short stature Congenital heart disease Face (Upturned nose, hooded eyes, low ears)
Williams syndrome
Short Hypercalcaemia Congenital heart disease Learning difficulty Face (Full lips, gapped teeth, upturned nose, wide mouth)
Perthes disease
Avascular necrosis of femoral epiphysis of femoral head then revascularisation and ossification
5-10 year old boy
Hip pain and limp
XRay for increased density then fragmented
Surgical, pin fixation in situ
Kohlers disease
Foot bone disease
Navicular bone, avascular necrosis
Osteochondroses
Osgood schlatters
Osteochondritis of patellar tendon insertion. Physically active adolescent boys. Hamstring tightness. Reduce activity, physio, splint
Wernicke korsakoff syndrome
Thiamine (B1) deficiency. From alcholol abuse
Wernickes= confusion, wide based gait, opthalmoplegia
Korsakoffs= no new memories, confabulation, lack of insight and apathy
Huntingtons disease
Chromosome 4, huntingtin gene, CAG repeats. Neostriatum loss. Chorea. slowed reaction times, increased reflexes, slowed dysdiachokinesia
Alzheimers disease
5As
Anticholinesterase inhibitors (galantamine, donepexil, rivastigmine; can cause bradycardia n epilepsy).
Higher educational level and CV helath is protective
Horners syndrome
Sympathetic fibres disrupted. Miotic, no dilatation, partial ptosis.
MS, Cavernous sinous thrombosis, pancoasts tumour, aortic aneurysm can all cause horners
Bells palsy
LMN. Pregnancy and diabetes risk factors
Oedema causes facial nerve entrapment in facial canal. Abrupt onset weakness. Mouth sags, dribbling, watering, impaired facial movements and expression.
Prednisolone
Parkinsons disease
Loss of dopaminergic neurones in substantia nigra.
Cogwheel rigidity, bradkinesia, resting tremor
L Dopa
Subthalamic nucleus stimulation
Peyronies disease
Scar tissue forms in penis. Causes bend. Collagenase injections can help
Turners syndrome
45X Short girl Hands and feet oedema Coarctation, absent kidney Webbed neck Ovarian dysgenesis. Oestrogen and growth hormone
Ashermans syndrome
Adhesions within the uterus
Poor fertility and little menstruation
Hysteroscopy
Pagets disease of the nipple
Itchy red scaly or crusted nipple from direct extension of intraductal adenocarcinoma.
Looks like nipple eczema, do a biopsy
Mastectomy or lumpectomy and radio
Whats the difference between Prader Willi and Angelman syndrome
Angelman the child has no maternal but two paternal, prader willi the child has no paternal but two maternal
Epigastric pain at night, haematemesis
Duodenal ulcer
Diarrhoea, weight loss, blood in stool, growth failure
IBD
Vomiting and recurrent abdo pain
Pancreatitis
Jaundice and recurrent abdo pain
Liver disease
Dysuria, secondary enuresis, abdo pain
UTI
Bilious vomiting abdo distension and pain
Malrotation
Alcohol dependence
- compulsion to drink
- prioritise drinking over other activities
- stereotyped pattern of drinking
- increased tolerance to alcohol
- repeated withdrawal symptoms
- relief drinking to avoid withdrawal
- reinstatement after abstinence
Can mental health act be invoked for substance misuse and dependence
No but it can be for secondary disorders
First rank symptoms of schizophrenia
Auditory hallucinations
Delusions of thought control
Delusions of control (passivity phenomenon)
Delusional perception
Define delusion
Unshakeable belief that is held in the face of evidence to the contrary and that cannot be explained by culture or religion
Define hallucination
A perception that arises in absence of a stimulus and is not subject to conscious manipulation
Hebephrenic schizophrenia
Prominent mood changes
Catatonic schizophrenia
Prominent psychomotor disturbances
Residual schizophrenia
From an early stage with psychotic symptoms to a secondary phase with negative symptoms
Diagnosing schizophrenia
2+ first rank, scoial occupational dysfunction, 6 month period with 1 month of symptoms.
Exclude mood disorder and substance missuse
Schizoaffective disorder
Prominent affective and schizophrenic symptoms in the same episode of illness. Different from post schizophrenic depression and bipolar
Bipolar
Bipolar 1= mania and major depression, bipolar 2= hypomania and major depression Psychological treatments Antipsychotics, benzos for manic Antidepressants for depressive Mood stabilisers to prevent relapse Lithium, lamotrigine, valproate
Cyclothymia
Numerous episodes of mild elation and mild depressive symptoms that do not meet the criteria for bipolar
Hypomania
Mood is elevated expansive or irrtiable. No psychotic features or marked impairment of social functioning
Depression
Low mood, low energy and anhedonnia
+poor apetite, sleep, libido, concentration, worthless, hopeless, psychomotor retardation
Psychological, social, SSRIs, SRIIs, TCAs
postpartum depression
Edinburgh post natal depression scale. Sertralline, CBT. Have a low threshold for MDT
Post partum pscyhosis
2 weeks post partum. Psychotic and affective symptoms. Psychosocial factors. Rapidly fluctuating
Anxiety
Exaggerated response to threat or danger. Lasts more than 3 weeks interferes with daily life.
Exervise, meditation, SSRIs or Benzos
OCD
Compulsions- senseless repeated rituals. Obsessions- stereotyped, purposeless words, ideas or phrases that come into mind.
CBT, Clomipramine, SSRI
Panic disorders
Reoccuring unexpected panic attacks. Fluoxetine
PTSD
Reexperiencing, autonomic hyperarousal, avoidance of things attached with event, hyper-vigilance, sleep disturbance, poor concentration
Amygdala
CBT EMDR
SSRIs
Phobia
Anxiety is only experienced in certain well defined situations that arent dangerous.
CBT, SSRI, TCA, pregabalin
Somatasisation disorder
Physical symptoms that can not be accounted for by a physical disorder or other psychiatric disorder
Personality disorders
Longlasting rigid patterns of thought, affect and behaviour
- Markedly disharmonious attiudes and behaviours
- Prevailing chronic abnormal behaviour patterns
- present in broad range of situations
- manifest before18 and continue into childhood
- personal distress caused by this
- occupational and social performance problems
Paranoid personality
Suspicious, preoccupied with conspiratorial explanations, distrusts others, holds grudges
Schizoid personality
Emotionally cold, lacks interest in others, rich fanatasy world, excessive introseption
Dissocial/ antisocial personality
Aggressive, easily frustrated, lack of concern for others, irresponsible, impulsive, unnable to maintain relationships, criminal activity, lack of guilt (psychopath)
Borderline emotionally unstable personality
Feeling of emptiness, unclear identity, intense and unstable relationships, unpredictable affect, threats or acts of self harm, impulsivity, pseudohallucinations
Impulsive emotionally unstable personality
Inability to control anger or plan, unpredictable affect and behaviour
Histrionic personality
Over dramatize, self centred, shallow affect, labile mood, seeks attention and excitement, manipulative behaviour, seductive
Narcissistic personality
high self importance, lacks empathy, takes advantage, gradiose, needs admiration
Anankastic personality
OCD, worrier, judgemental
Anxious personality
Extremely anxious and tense, self concious and insecure, timid, desires to be liked
Dependent personality
Passive, clingy, submissive, excess need for care
Migraine headache
Featureful, unilateral, episodic. Sumatriptan, propanolol, aspirin
Tension headache
Bilateral pressing headaches. Featureless. Lifestyle advice. Asprinin
Medication overuse headache
Worsens on analgesia
Cluster headache
Excruciating pain, ipsilateral, autonomic. O2, sumatriptan. Nifedipine, prednisolone
How do you reverse warfarin
Beriplex and vitamin K
Stroke
Ischaemic, asprin and alteplase within 4.5 hours
Haemorrhagic: beriplex n vit K, IV mannitol
Anterior cerebral artery stroke symptoms
Leg signs, trunk apraxia, frontal lobe= drowsy and less spontaneous speech
middle cerebral artery stroke symptoms
Facial drop, dysphasia, leg and arm weakness
Posterior cerebral artery stroke symptoms
Homonymous hemianopia. Visual signs.
Posterior circualtion stroke symptoms
Big. Paresis, LOC, locked in, vertigo
Occipital lobe function
Vision
Temporal lobe function
Language comprehension, hearing, memory, behaviour
Pitiutary gland function
Hormones
Growth
Fertility
Brainstem function
Breathing
Blood pressure
Heartbeat
Swallowing
Cerebellum function
Balance
Coordination
Fine motor control
Parietal lobe function
Judgement, calculations, reading, writing
Cerebellar symptoms
Dysdiadochokinesis, Ataxia, Slurred speech, hypotonia, intention tremor, nystagmus, gait
Tumours, infection, stroke, Arnold Chiari malformation, toxic, friedreichs ataxia, MS
Epilepsy
Recurrent tendency to spontaneous intermittent, abnormal electricity in part of the brain manifesting in seizures
Focal= carbamazepine (sodium CB)
Generalised= sodium valproate (CCB)
NEAD
Resemble seizures but arent associated with electrical activity in the brain. Comorbidities with IBS and fatigue, functional. Immobilisation of body parts is a sign
Narcolepsy
(Gelineuas syndrome). Young man, succumbs to inappropriate sleep, hynogogic hallucinations, cataplexy, sleep paralysis. Autoimmune destruction of hypothalamic neuros. Modafinil stimulant is the treatment
Cataplexy
Bilateral loss of tone in antigravity muscles provoked by emotions. Associated symptoms. Brief but injury can occur.
Shingles
Oral analgesia, Acicolvir.
In one dermatome normally, can be opthalmic.
Herpes Zoster, caused by reactivation of Varicella Zoster
Huntingtons
Autosomal dominant neurodegenerative disorder characterised by lack of inhibitory GABA.
Chromosome 4, CAG
Chorea, dysarthria, dysphagia
Vascular dementia
Brain damage from vascular pathology. Step wise deterioration
Donepezil (AChI), Memantine (antiglutamate)
Alzheimers disease
Accumulation of Beta amyloid plaques and tau protein. 5As. Donepezil, rivastigmine
Normal pressure hydrocephalus
Reversible cause of dementia.
Wet whacky wobbly. MRI= hydrocephalus with enlarged ventricles.
VP shunt
Hydrocephalus
Abnormal accumulation of CSF in ventricles, often due to blocked aqueduct. In children you get bulging of fontanelles. Brain damage from pressure. Ventirculoperitoneal Shunt
Brain tumours
Loss of function, seizures, symptoms of raised ICP, lethargy and tiredness.
Astrocytomas, gliomas, oligodendroglial
Surgery, chemo if glioma, oral dexamethasone
What causes lethargy and tiredness in brain tumours
Pressure on brainstem
MS
Chronic autoimmune T cell mediated inflammtory disorder causing 2 or more CNS lesions disseminated in time and space (exclude similar). MRI.
IV methpred, betaferon, nataluzimab
GBS
Acute ascending inflammatory demyelinating polyneuropathy affecting the peripheral nervous system (Schwann cells) after and URTI or GI infection.
IV IG
Plasma exchange
Enoxaparin
Motor neurone disease
Cluster of major degenerative diseases characterised by selective loss of neurones in the motor cortex, CN nuclei and anterior horn cells. AMLS= upper and lower. Stumbling, foot drop, proximal myopathy, weak grip, aspiration pneumonia. Riluzole Amitryptilline Baclofen Diclofenac MDT
Cerebral palsy
Chronic disorders of posture and movement caused by non progressive CNS lesions sustained before 2 years old. Leading to delayed motor development, CNS signs, learning disability and epilepsy.
MDT
Baclofen, physio, respiratory support
Neurofibromatosis
Cafe au lait spots, freckling, dermal fibromas, nodular neurofibromas. Lisch nodules.
T1= more common, more cafe, dermal fibromas
T2= also get acoustic schwanoma, hearing loss?
Meningitis
Inflammation of the meninges of the brain. Neck stiffness, headache, fever. Non blanching, petechial and purpuric rash.
Ben Pen if in community, cefotaxime in hospital. Over 50 or immunocompromised, add in IV amoxicillin
Ciprofloxacin prophylaxis
Encephalitis
Infection and inflammation of the brain parenchyma. Altered mental state, headache, fever. IV Aciclovir (if viral) Primidone antiepileptic IM BenPen if suspect meningitis
Bovine papular stomatitis
Parapoxvirus associated with papular and erosive lesions on the mouth and lips
Bulbar palsy
Disease of CN9-12. Tongue, muscles of talking and swallowing, speech.
Caused by MND, GB, polio, MG, brainstem tumours
Myastenia Gravis
Autoimmune disease against nicotinic ACh receptors in the neuromuscular junction. Anti-AChR IgG. Increasing muscle fatigue (CN, resp, tendon reflexes fatiguable)
Serum AntiAChR
Pyridostigmine (anticholinesterase)
Myasthenic crisis
Weakeness of respiratory muscles during relapse. Monitor FVC, treat with plasmaphoresis and IV Ig
Radiculopathy
(Root compression). Pain/ electrical sensations at the level of the compression, with dumbness, dull relexes, weakness and wasting below. Pain management, surgery
Sciatica
Shooting pain down the leg, pain management and surgery
Peripheral neuropathy
Can be motor (GBS, lead poisoning, CMT) or sensory (DM, renal, leprosy). Foot care and shoe choices, splinting of joints, amitryptilline
Mononeuropathy
Focal demyelination at the point of compression can cause disruption of conduction. Splint, steroid injection, decompression surgery
Spinal cord compression, cervical spondylosis.
Progressive symptoms, UMN leg signs, LMN arm signs, incontinence, hesitancy, urgency. Urgent MRI. Refer, cervical collar, laminectomy
Subarrachnoid haemorrhage
Spontaneous bleeding into subarachnoid space (between arachnoid layer of meninges. Sudden thunderclap occipital headache, neck stiffness, kernigs sign, brudzinskis sign.
Head CT, star shaped lesion
IV fluids, IV nifedipine.
NEUROSURGEON
Extradural haematoma
Young adults. Head injury, LOC, lucid interval, followed by LOC. CT Head, Lemon, Biconvex. Skull XR can show a fracture across the middle meningeal artery. ABCDE. IV Mannitol, NEUROSURGEON
Subdural haematoma
Small brains, alcohol, dementia, child. Bleeding from bridging veins and venous sinuses. Fluctuating consciousness, changes. CT head. Crescent shape. ABCDE. IV mannitol
Anterior cord syndrome
Ischaemia of the anterior cord artery. Corticospinal tract so complete motor paralysis below. Loss of pain and temperature as spinothlamic. Still have proprioception and vibration as dorsal columns. Bad prognosis
Status epilepticus
Seizures lasting more than 30 minutes without intervening consciousness.
IV Diazepam
IVI Phenytoin
Seek ICU help
Raised ICP
Headache worse on coughing, leaning forwards Alterered GCS History of trauma Pupil changes Papilloedema and reduced visual acuity Craniotomy or Burr hole IV Mannitol Sedation Identify cause. Herniation and coning. Uncal herniation (3rd nerve) Cerebellar tonsil herniation (6th nerve palsy) Subfalcian herniation (frontal lobe)
Coma
Unrousable unresponsiveness ABC IV access Stabilise cervical spine Blood glucose Control seizures ABG, FBC, U&E, LFT, ethanol, toxin screen, drug levels. Blood and urine culture. CXR, CT head
Brain abscess
Inflammation and collection of infected materials coming from local or remote infections. Headache, neck stiffness, fever, N and V,
Ear, dental or sinus abscess
Pneumonia or trauma
Aspiration surgery, craniotomy, antibiotics
Myopathy
Primary disorder of muscle with gradual onset symmetrical weakness. Proximal, preserved reflexes, no sensory problems, no fasciculation
Steroids, inflammatory, metabolic, myotonic, statin, muscular dystrophy, polio
UMN signs
Babinskis sign Spasticity (increased muscle tone) Refelexes brisk Flexed upper, extended lower Emotional liability
LMN signs
Reduced muscle tone
Muscle wasting
Fasciculations
Reduced reflexes
GCS categories
Eye verbal motor
GCS Eye order
None, pain, speech, spontaneous
GCS verbal order
None, incomprehensible, innapopriate, confused, orientated
GCS motor order
None, extension, flexion, withdraws, localises, obeys command
Dermatomes Nipple Belly button Knee Big toe Perianal Anus
T4 T10 L4 L5 S4 S5
Myotome for
pelvis
penis
C345 keeps diaphragm alive
S234 keeps the penis off the floor
Childhood epilepsy
Focal- carbamazepine Generalised- sodium valproate EEG Monotherapy to reduce SE Liaise with school
ADHD
Cannot sustain attention, excessively active, socially disinhibited, may be poor at relationships, prone to temper tantrums, poor school performance.
Educational psychologist, behaviour programme at school, parenting interventions
Methylphenidate
Autism spectrum disorders
Presents at 2-4yo with social interaction, speech and language disorder and imposition of routines with ritualistic and repetitive behaviour.
Behaviour modification- applied behaivoural analysis
Also often learning difficulties and ADHD, epilepsy
Anorexia nervosa
Distorted body image, determined efforts to lose weight, arrest of puberty, cessation of periods.
Family therapy and therapy to restore body weight
Increased risk of suicide, malnutrition and infection
Bulimia
Overating followed by self induced vomiting. As in anorexia, there is a morbid preoccupation with weight and body shape
Undescended testes
More common in preterm
Retractile? Palpable? Impalpable?
Laparoscopy is best (US and hormonal tests too)
Orchidopexy
Testicular torsion
Lower abdo or inguinal pain
6-12 hours to act
Undescended= higher risk
Surgery is needed and fixation of the contralateral testes to ensure that that one does tort
Premature sexual development
Secondary sexual characteristics before 8 in girls or 9 in boys.
US of ovaries and uterus in girls
MRI of hypothalamic region in boys
Girls can have excess GnRH analgoue (Zolardex).
Early growth spurts and fusion of growth plates results in reduced final height.
Thelarche
Breast development
Pubarche
Pubic hair development
Hypothyroidism
Congenital hypothyroidism can be identified on guthrie test (raised TSH)
Caused by maldescent of the thyroid and athyrosis; or iodine deficiency, dyshormonogenesis too.
Lifelong thyroxine treatment: ensures adequate intelectual development
Gonadotrophin insufficiency
Can be caused by Prader Willi and congenital hypopituitarism.
Results in a small penis and cryptorchidism
Hypothalamic tumours
Excess LH and FSH can lead to premature puberty, can also cause adrenal insufficiency. May present with a headache
Congenital adrenal hyperplasia
Autosomal recessive of adrenal steroid biosynthesis (deficiency of 21 hydroxylase)
Girls= virilisation and male characteristics Boys= salt loss, tall stature and precocious puberty
Long term glucocorticoids, mineralocorticoids and salt if needed. Surgery for girls. Monitor bones and plasma androgens
Androgen insensitivity syndrome
Under virilisation in a boy
Can cause inguinal hernia in a girl
Inadequate androgen action as unable to respond to androgens.
Obesity
Obese = BMI> 98th centile for age and sex
Overweight=BMI>91st centile for age and sex
Hypothyroidism, Cushing and Prader Willi rare
Lifestyle and cultural changes needed
Child abuse
Physical, emotional, sexual abuse, neglect, fabricated or induced illness.
Interests of the child should be kept uppermost to ensure protection from harm
Good communication with parents and child is vital
Microcytic anaemia
Low MCV and low MCH. Low serum ferritin.
Low Iron
Beta thalassaemia, alpha thalassaemia, anaemia of chronic disease
Dietary advice and oral iron
Beta Thalassaemia major
Beta globin gene, therefore cant make HbA.
Severe anaemia, failure to thrive/ growth failure, hepatosplenomegaly
Regular blood transfusions and iron chelation (desferrioxamine)
Beta Thalassaemia trait or alpha thalassaemia trait
Mild iron deficiency and can cause diagnostic confusion
Alpha thalassaemia
Deletion of all 4 alpha globin genes. Barts hyrdrops, death in utero or within hours of birth
Haemolytic disease of the newborn
Anaemia, hydrops, hepatosplenomegaly and jaundice. Rare now as antenatal screening, but can still happen as there are other RBC antibodies such as Kell. Anti D immunoglobulin is given to rhesus negative mothers.
Sickle cell anaemia
Autosomal recessive
Sickled red cells lead to ischaemia in organs and bones.
Anaemia, infection, painful crises, sequestration crises, splenomegaly, growth failure, gallstones, behaviour and learning problems.
Acute chest syndrome and strokes also
Management
-prophylactic penicillin and immunisation
-focial acid and maintain good hydration
-analgesia and blood transfusion for crises.
Hydroxyurea as treatment or bone marrow transplant
Fanconi anaemia
Aplastic anaemia
Autosomal recessive
Abnormal radii and thumbs, short, micropthalmia, pigmented skin
Dx: Increased chromosomal breakage of peripheral blood lymphocytes
Risk of bone marrow failure or ALL so treatment is Bone Marrow Transplant
Haemophilia
X linked recessive disorders (A=8, B=9)
Recurrent spontaneous bleeding into joints and muscles at about 1 year of age.
Treatment is recombinant factor 8 or 9 and desmopressin.
Challenging treatment as IV access and inhibitors
Immune thrombocytopenia
2-10 years
Widespread petechiae and purpura and superficial bruising
FBC and blood film
Self limiting so no treatment normally
Leukaemia
FBC, Bone marrow examination ?Blast cells, morphology phenotyping
Normally ALL. rarely acute myeloid.
Vincristine and dexamethasone
Brain tumour in children
Astrocytoma, medulloblastoma, ependymoma, craniopharyngoioma
MRI scan no LP
Surgery for hydrocephalus, get a tissue biopsy
Neuroblastoma
Under 5 Neural crest tissue in adrenal medulla Raised urinary catecholamine level MIBG scan Surgery and chemo for mets
Retinoblastoma
Malignant tumour of retinal cells. Chromosome 13= bilateral White pupillary reflex MRI and examination under anaesthetic Chemo then lazer therapy
Bone tumour
Osteogenic sarcoma or ewing sarcoma (younger). Persistent localised bone pain. Then mass.
Plain XR, MRI, bone scan
Ewing= big soft tissue mass
Combination chemo then surgery, en bloc resection
Hepatoblastoma
Abdominal distension and mass
Elevated serum alpha fetoprotein
Fragile X
Moderate- severe learning difficulty Macrocephaly Macro orchidism Long face, large everted ears, mitral valve prolapse, scoliosis, autism, hyperactive CGG repeats
Cystic fibrosis
Sweat test 60-125 then gene testing
Defective CTFR on chromosome 7
Thick meconium, Mucopurulent lung secretions and imapaired ciliary function, pancreatic enzyme deficiency
MDT Dornase alpha, Pancreatic enzyme replacement, MDT
Duchenne, Becker, Dystrophy
X linked, waddling gait and language delay. Gowers sign (turn prose to rise), fat calves.
Exercise, lengthening achilles, CPAP for sleep
Duchenne at 5, becker less serious at 11
Osteogenesis imperfecta
Autosomal dominant
Blue sclera, fractures, hearing loss
Bisphosphonates prevent fractures
Type 1 common, Type 3 fatal
Rickets
Nutritional- breast feed to late infancy
Serum calcium and phsophate low. Plasma alkphos high, PTH high, 25-VitD low
Xray= cupping and fraying of metaphysis and widened epiphyseal plate
Transient synovitis
Common cause of hip pain or limp.
Different to septic arthritis as no fever, child looks well, resolves within a week. Comfortable at rest, can get analgesia
Septic arthritis
Acute onset, high fever, child looks ill, severe pain, raised ESR, fluid in joint, widened joint space.
Joint aspiration treatment
Prolonged antibiotics, rest and analgesia.
Severe joint damage if not treated
Osteomyelitis
Fever, painful, immobile limb, swelling, extreme tenderness, especially on moving limb
Positive blood cultures
Parenteral blood cultures
Surgical drainage if unresponsive
Placenta praevia
Placenta implanted in uterine lower segment
Marginal= near Major= over
RF: large placenta, scarred uterus, high parity/age
Ultrasound
Painless APH
Scan at 32 then 37. Admit whenever bleeding and give steroids. If not then do a C section
Placenta accreta
Abnormal adherence of all or part of the placenta to the uterus. Predisposes to PPH and they should have a csection
Placenta increta
Abnormal adherence and infiltration of the placenta into the myometrium. Predisposes to PPH and they should have a csection
Placental abruption
Seperation of part or all of the placenta before delivery, after 24 weeks.
IUGR, preeclampsia, AI, smoking, previous all risk factors.
Can cause fetal death, DIC, renal failure and maternal death.
Painful APH. Tender woody uterus.
CTG
Induce labour, c section if baby in distress. Wait if preterm and minor
Uterine rupture
Can be de novo or from an old scar. The fetus is extruded and the uterus contracts down and bleeds from the rupture site, causing fetal hypoxia and massive internal maternal haemorrhage. Lower is not as bad as less vascular.
Scarred uterus, congenital abnormalities and big babies.
Maternal resus with fluid and blood.
Laparotomy to deliver baby.
Cervical show
Effacement is when the normally tubular cervix is drawn up into the lower segment until it is flat. This is often accompanied by a ‘show’ or pink/white mucus plug from the cervix and/or rupture of the membranes, causing release of liquor.
Vasa praevia
Occurs when a fetal blood vessel runs in the membranes in front of the presenting part. (Velamentous insertion) Painless moderate vaginal bleeding at amniotomy or spontaneous rupture of the membranes and severe fetal distress
Baby blues
Third day blues- temporary emotional lability requiring support and reassurance.
Edinburgh postnatal depression scale for post natal depression.
Puerperal pscyhosis
Abrupt onset of pscyhotic symptoms. 4th day. Needs psych admission and major tranquillizers after exclusion of organic illness
Puerperal infection
Uterine, wound and urine infection.
Can also get chest or perineal, or mastitis.
Pyrexia, pain, prolonged SROM.
Endometritis= abx and sensitivity and ERPC
Others= clean, abx, physio
Rectocele
Herniation of the anterior wall of the rectum into the vagina. Rectal symptoms
Cystocele
Herniation of the bladder into the vagina. Urinary symptoms
Endometriosis
Endometrium outside the uterus. Peritoneal inflammation causes fibrosis, adhesions and chocolate cysts.
Cyclical pelvic pain, dysmenorrhoea, dyspareunia, subfertlity, pain passing stool.
Laparoscopic biopsy
Mirena coil then COCP
Laparoscopic ablation
Adenomyosis
Endometrium grows into the myometrium to form adenomyosis.
Regular heavy menstruation (menorrhagia)
MRI
Mirena coil
Androgen insensitivity syndrome
When male has cell receptor insensitivity to androgens; these are then converted peripherally to oestrogens. Actually a boy, presents amenorrhoeic with testes which need removing cos of malignancy risk
Atrophic vaginitis
Due to oestrogen deficiency (before menarche, during lactation or after menopause). Oestrogen cream or HRT
Kohlers disease
Navicular bone loses its blood supply causing bone disorder of the foot in a boy between 6 and 9
Discoid meniscus
Anatomical variation of the lateral meniscus of the knee, presents with pain, swelling and a snapping sound
Slipped femoral epiphysis
Adolescent with limp or hip pain.
Obese boy, displacement of femoral head posterio-inferiorly requiring prompt treatment to prevent avascular necrosis.
XRay in from frog lateral view
Surgical management with pin fixation in situ
Developmental dysplasia of the hip
Identified on screening at birth or 8 weeks, detection of assymetry of skinfolds around hip, limited abduction of the hip, shortening of the affected leg or a limp
Juvenile idiopathic arthritis
Persistent joint swelling presenting before 16yo in the absense of infection or any other defined cause. Number of joints affected? Systemic? Rheumatoid factor? HLA B27? Morning stiffness and pain.
-Anterioir uveitis, flexion contractures, growth failure,
MDT, NSAIDs, Joint injections, methotrexate
Try and avoid systemic corticosteroids and biologics
Impetigo
Staph or strep erythematous macules which may become vesicular, pustular or bullous. Coamoxiclav or flucox.
Highly contagious. Nasal carriage.
Face or neck mainly
Slapped cheek syndrome
Parvovirus B19
Erythema infectiosum- slapped cheek then lace like rash on trunk and limbs.
Can cause aplastic crisis in haemolytic anaemia children.
Candida
Can complicate nappy rashes. Erythematous in skin flexures and can be sattelite lesions.
Topical antifungal agent
Toxic shock syndrome
High fever, hypotension, diffuse erythematous macular rash.
Toxin produced by Staph or Group A strep.
Can cause serious complications- desquamification of palms, soles, fingers and toes.
PVL toxin- Panton Valentine Leukocidin
IVIG
Toddlers diarrhoea
Chronic non specific diarrhoea
Undigested vegetables common
Child well, will be fine. Intestinal motility immature
Better to have fat than fruit juice
Colic
Paroxysmal inconsulable crying, drawing up of kneees and excessive flatus
Supportive treatment, will resolve. is benign
Gripe water may help.
First 4 months of life
(If severe could be GORD or cows milk allergy)
Biliary atresia
Destruction or absence of the extrahepatic biliary tree and intra hepatic biliary ducts.
Jaundice, hepatosplenomegaly, white stools
Surgery or chronic liver failure and death
Laparotomy and cholangiography= no biliary tree
Liver transplant
Choledochal cysts
Cystic dilatations of the extrahepatic biliary cystem
Abdo pain, mass, jaundice, cholangitis
Ultrasound
Surgical excision
Neonatal hepatitis syndrome
IUGR and hepatosplenomegaly at birth is distinctive
Liver biopsy= giant cell hepatitis
Liver failure (fulminant hepatitis)
Large hepatic necrosis with subsequent loss of liver function.
Paracetamol overdose, viral hepatitis, metabolic conditions.
Jaundice, encephalopahty, coagulopathy, hypoglycaemia and electrolyte disturbance
Highly derranged bloods (Alk phos, ALT, AST, ammonia\0
Treat all the complications and then transplant
Pyelonephritis
Inflammation of the kidney as a result of a bacterial infection.
Ecoli, klebsiella, proteus
Can damage the growing kidney by forming a renal scar which may result in HTN and CKD
Nocturnal enuresis
More males.
Over 6 is abnormal.
Explanation, star charts, enuresis alarm
Sometimes desmopressin
Acute kidney injury
Sudden potentially reversible reduction in renal function.
Prerenal: hypovolaemic, circulatory failure
Renal: Vacular, tubular, glomerular, pyelonephritis
Postrenal: obstruction
Treat underlying cause, metabolic abnormalities, dialysis if needed
Chronic renal failure
<15ml/ min/ 1.73m
Congenital (structural malformation/neuropahty)
US, anorexia and lethargy, failure to grow, renal rickets, HTN, proteinuria, anaemia.
Mx: Diet, Vit D, water, EPO, GH
Dailysis and transplant
Nephrotic syndrome
OEDEMA (anywhere)
Heavy proteinuria
Low plasma albumin
Oral pred
Hypospadies
Urethral opening proximal to normal meatus 1) ventral urethral meatus 2) hooded dorsal foreskin 3) chordee (curved erection) Surgery
Resuscitation
5 initial rescue breaths then
15 chest compressions to 2 breaths at a rate of 100-120 compressions/ min
Respiratory distress syndrome
Very preterm infants
Surfactant deficiency
Antenatal corticosteroids and surfactant therapy helps
Bronchopulmonary dysplasia
Oxygen requirement at a post menstrual age of 36 weeks.
Damage from artificial intubation or infection.
Additional oxygen therapy
Meconium aspiration
Baby past due date
Large bore suction cannula if causing problems
hypoxic ischaemic encephalopathy
Birth asphyxia
Can cause cerebral palsy
TORCH infection
Toxoplasmosis gondii (protozoan)
Retinopathy
Cerebral calcification
Hydrocephalus
Undercooked food and cat litter
Neonatal jaundice and kernicterus
Can be caused by rhesus haemolytic disease
Give exchange transfusion, phototherapy
Phototherapy and excess water
Kernicterus caused by bilirubin deposition in basal ganglia
Necrotising enterocolitits
XRAY= Intramural air, Air under diaphragm and in portal tract
Distended bowel loops
Bacterial infection of ischaemic bowel,
Stop feeding, give broad spectrum abx n feed
Gastrochicis
Bowel protrudes through defect in anterior abdomen wall
Protein loss and dehydration (wrap it)
Surgery
Bowel atresia
Obstruction and distension
Absense at the normal site
Surgical treatment
Gestational diabetes
Tight control preconception.
Macrosomic, hyperglycaemia, hyperinsulinaemia, increased risk of congential abnormalities
Increased risk of asphixiation and birth trauma
When born can get hypo n Polycythaemia
Maternal hyperthyroidism
Tachycardia on CTG
Goitre on US
Irritability, weight loss, tachycardia, heart failure, diarrhoea, exopthalmos
Carbimazole
Hypoglycaemia
Small, poor glycogen stores, maternal diabetes, low birth weight, large for date but also IUGR
= jittery, irritable, apnoea, lethargy, drowsy, seizures
Early n frequent milk feeds
IV dextrose
Glucagon or hydrocortisone
Group B strep
Preterm, prom, chorioamniotitis
Early sepsis (=RDS and pneumonia)
Late over 3 month (=meningitis or local)
Give penicillin
Listeria
Listeria monocytogenes
Leads to respiratory distress, apnoea, temperature instability
Amoxicillin and gentamycin
HSV encephalitis
Passage through infected birth canal
localised herpetic lesions or encephalitis
Aciclovir
C section if known disease
Cleft lip
Failure of fusion of the frontonasal and maxillary processes
Chromosomal disorder, mother epilepsy
Orthodontics help with feeds, dental prostheses
Surgery
Cleft palate
Failure of fusion of the palantine process and nasal septum
Secondary secretory otitis media common
Surgery
When do you get vaccinated before youre 1
8, 12, 16 weeks
Which vaccinations do you get at 8 weeks
6 in 1
Rotavirus
Pneuomcoccal vaccine
Men B
Which vaccinations do you get at 12 weeks
6 in 1
Rotavirus
Which vaccinations do you get at 16 weeks
6 in 1
Pneumococcal vaccine
Men B
When do you get vaccinated between 1 and 15
1 year 2-10 years 3 years and 4 months 12-13 years 14 years
What vaccinations do you get at 1 year
Pneumococcal vaccine
Men B
Hib/MenC
MMR
What vaccinations do you get at 2-10 years
Flu vaccine
What vaccines do you get at 3 years and 4 months
MMR
4 in 1 preschool booster
What vaccine do you get at 13-14 years
HPV vaccine
What vaccine do you get at 14 years
3 in 1 teenage booster
Men ACWY
When do you get vaccines as an adult
65 years
70 years
Every year after 65
What vaccine do pregnant women get from 16 weeks
Pertussis
What vaccine do you get at 65 years
Pneuomococcal vaccine
What vaccine do you get at 70 years
Shingles vaccine
Whats in the 6 in 1 vaccine
Diptheria Tetanus Polio Whooping cough Hep B Hib
Whats in the 4 in 1 vaccine
Diptheria
Tetanus
Polio
Whooping cough
Whats in the 3 in 1 vaccine
Diptheria
Tetanus
Polio
When should a child be crawling
8-9months
Thrush
Candida albicans Resembles cottage cheese Broad abx, immunosupressed Inflamed, superficial dysparenia Oral fluconazole
Chlamydia
Chlamydia trachomatis
Dysuria, white pus
NAAT (F=Vulvovaginal swab, M= first pass urine)
Azithromycin 1g stat
Bacterial vaginosis
Grey/ yellow, thin, fishy discharge. Microscopy, metronidazole
Trichomonas
Trichomonas vaginalis Green frothy discharge Strawberry cervix Wet microscopy Metronidazole
Gonorrhoea
Neisseria gonorrhoea
NAAT
Azithromycin + IM cefrtiaxone
Herpes
1=oral, 2=genital
Multiple painful ulcers
Swab for viral culture
PO acyclovir
Syphilis
Treponema pallidum
Single painless papule- chancre
Blood serology for virus
IM BenPen
Genital warts
HPV
STI screen
Cryotherapy/ podophyllotoxin cream
HIV
Good management before conception PCP prophylaxis Maternal and neonatal antiretroviral C section Avoid breastfeeding
Contact tracing
Identification and contacting recent sexual partners, carried out by the patient normally
Fibroadenoma
Under 30
Firm, smooth, mobile, painless
Breast mouse
Benign overgrowth, USS/Fine needle aspiration or excission if large
Breast cyst
Perimenopausal
Benign, fluid filled, not fixed
Can be painful
Fine needle aspiration diagnosis
Breast abscess
Fluid filled, infective
Needle drainage, ultrasound
Flucoxacillin
Pagets disease of the nipple
Extension of intraductal adenocarcinoma. Itchy, red scaly crusty. Similar to nipple eczema. Do a biopsy then treat with surgery
Ductal carcinoma in situ
Presence of abnormal cells within the milk ducts of the breast
Three stage breast lump investigation
Clinical examination
Imaging (US if <35, then mammo and US)
Histology (Fine needle aspiration)
ABCDE of breast cancer
Assymetry Border Colour Diameter Evolution
Breast cancer types
Non invasive ductal carcinoma
Invasive ductal carcinoma
Invasive lobular
Medullary
Breast implant
MRI for imaging Capsule formation Infection Rupture Shape changes
Human sexuality
Persons capacity for sexual feelings and orientation
Determined in adolescense
Oligohydramnios
Hypoperfusion of the placenta
Can be caused by preeclampsia
Polyhydramnios
Excessive amniotic fluid
can be caused by diabetes, fetal abormality or idiopathic
Instrumental delivery
Prolonged active second stage, maternal exhaustion, fetal distress
Prerequisites: fully dilated, head deeply engaged, analgesia, indication, empty bladder
Laceration, PPH, 3rd degree tears
Laceration, facial injury, hypoxia
Multiple pregnancy
IVF, genetic, older 3+ fetal poles, vomiting, ultrasound Serial ultrasounds, folic acid, anomaly scan Increased surveillance C section if first twin not cephalic
Transverse/ oblique lie
Lie of fetus not parallel to long axis of uterus
Admit at 37
C section if not corrected by 41
Breech
Presenting part is feet or buttocks
External cephalic version at 37
Cord prolapse
After membranes have ruptured the cord prolapses below the presenting part.
Patient on all fours
C section normally
Obstructed labour
Fetus does not exit the uterus during labour despite normal uterine activity, due to a physical blockage
More common in developing world
Hypoactive uterus
Atony
Following long labour twins, nulliparous
Misoprostolol
Cephalopelvic disproportion
Inability to deliver uterus despite
-adequate uterine contraction
-absence of malpresentation or malrotation
C section
Gonorrhoea in pregnancy
IM Ceftriaxone and arithyromycin
Treatment reduces incidence of preterm birth
Group B strep in pregnancy
Intrapartum penicillin if at risk, 3rd trimester screening
Anaemia in pregnancy
Folic acid (especially if epileptic or previous neural tube defect) IV if bad and poorly tolerated
UTI in pregnancy
Preterm labour, anaemia, perinatal mortality
Often E Coli
Bacteria should be cultured at booking visit
Secondary post partum haemorrhage
Due endometriosis or RPOC. Give antibiotics, do evacuation of products.
Primary post partum haemorrhage
Blood lost within 24 hours of delivery -minor 500-1000 -major 1000+ Uterine atony, retained placental parts, lacerations Ergometrine Bimanual uterine compression Haemostatic suture
VTE in pregnancy
Pregnancy is prothrombotic Immobility, clotting factors increased, fibrinolytic activity is reduced Doppler for DVT CXR, ABG and CT for PE Subcut LMWH
Rhesus immunisation
Maternal antibody response against fetal RBC antigen. AntiD prophylaxis at 28 weeks (antiC and antiKell exist too) Severe anaemia, jaundice, hydrops Blood transfusion needed
Parkinsons
Pill rolling tremor
Cog wheel rigidity
Bradykinesia
Levodopa, ropinirole
Falls
Event where person inadvertantly comes to rest at a lower level.
Can cause pressure ulcers, rhabdomyolitis, dehydration, fractures
Incontinence
Stress, urge, functional
Pelvic floor exercises
Incontinence diary
Delirium
Acute, transient, reversible state of fluctuating impairment of consciousness, cognition and perception.
Infection, drugs, intracranial and environmental causes
Hypoactive or hyperactive
Dementia
progressive chronic deterioration in cognition, perception or memory.
Alzheimers, lewy body, vascular
Anticholinesteras- rivastigmine
Osteoporosis
Reduced bone density due to imbalance between bone remodelling and resorption
Smoking, steroids, FHx, underweight, early menopause
Bishosphonates like alendronic acid
FRAX
Suicide
Intentional self inflicted death
Underlying mental health issues
Focus on why, and understand whole situation
Look at the means and protective factors
Old age psychiatry
Specialised hollistic care for older people with mental health issues including dementia, depression and schizophrenia
Mental health law
To detain someone it must be
- mental health disorder
- nature or degree to warrant detention in hospital
- risk to self, others of health
Antipsychotics
1st gen= sulpiride, haloperidol, flupentixol, chlorpromazine (more EPS)
2nd gen= olanzapine, risperidone, quetiapine, aripiprazole (MSE)
Antidepressants
SSRI Tricyclic TCA Serotonin noradrenaline reuptake inhibitors (venlafaxine, duloxetine) Tetracyclic Monamine oxidase inhibitors
Mood stabilisers
Lithium
Olanzapine (antipscyhotic)
Anticonsulvants
Tranquilisers/ anxiolytics
First and second line talking treatment
Sertraline SSRI
Benzodiazepine
Pregabalin
Lithium toxicity
Renal impairment, tremor, confusion, thyroid dysfunction, weight gain
Clozapine toxicity
Weight gain, agranulocytosis
Paraphilias
Condition characterised by abnormal sexual desires
Sexual dysfunction
a problem occurring during any phase of the sexual response cycle that prevents the individual or couple from experiencing satisfaction from the sexual activity.
Sexual aversion disorder
Persistent or recurrent extreme aversion to and avoidance of all or almost all genital sexual contact with a sexual partner.
Hypoactive sexual desire disorder
Persistent deficient sexual/erotic thoughts or fantasies and desire for sexual activity
Female sexual arousal disorder
Persistent deficient sexual/erotic thoughts or fantasies and desire for sexual activityse
Erectile disorder
Difficulty in developing or maintaining an erection suitable for satisfactory intercourse
Chronic, medical, hormonal disorders. Ineffective stimuli. Pain.
Sildenafil, alprostadil (injection or pellet intraurethral)
Orgasmic disorder
Orgasm either does not occur or is markedly delayed
Ageing, chronic medical and hormonal problems.
Psychotherapy and physical meds
Delayed/ inhibited/ rapid ejaculation
Inability to control ejaculation sufficiently for both partners to enjoy sexual interaction
Local anaesthetic and behavioural interventions (stop, start, squeeze)
Retrograde ejaculation
Semen enters bladder instead of emptying into penis during ejaculation.
Look for presence of spermatozoa and fructose in urine
Dyspareunia
Pain during intercourse in either women or men. Often attributed to local pathology and should then be properly categorised under the pathological condition.
Vaginismus
Spasm of the pelvic floor muscles that surround the vagina, causing occlusion of the vaginal opening. Penile entry is either impossible or painful (ICD)
Vulvodynia
Vulvodynia is persistent, unexplained pain in the vulva
Azoospermia
Absence of sperm in the ejaculate.
Neuroleptic malignant syndrome
Long term use can produce movements of the face (tardive dyskinesia)
Serotonin syndrome
Cognitive changes
Autonomic changes
Neuromuscular changes
Electroconvulsive therapy
Can be used in treatment resistent depression
Counselling
Counselling, CBT and psychoeducation can be done in primary care.
DBT, psychoanalytic, group and family therapy are specialist
Hypospadies
Ventral urethral meatus
Downward curve of the penis
Dorsal hood
Anejaculation
Pathological inability to ejaculate in males, with or without orgasm
Dysfunctional endometrial bleeding
irregular uterine bleeding that occurs in the absence of recognizable pelvic pathology, general medical disease, or pregnancy
Menopause
Permanent cessation of menstruation resulting from loss of ovarian follicular activity
Premature if before 40
Hot flushes, insomnia, skin, vagina and breast atrophy, hair loss, prolapse, osteoporosis, CV disease
Low antimullerian hormone, high FSH
Consider HRT and bisphosphonates
Menarche
Onset of menstruation
Normally last manifestation of puberty, 13yo average
Before 16 (or 14 if no other characteristics)
23-35 days
8 days bleeding, less than 80ml total
Essential hypertension
When the blood pressure exceeds 140/90 before 20 weeks
Preeclampsia
Multisystem disease unique to pregnancy that usually manifests as hypertension (blood pressure [BP] >140/90 mmHg) after 20 weeks with proteinuria that is due to:
Endothelial cell damage and vasospasm, which can affect the fetus and almost all maternal organs. It is of placental origin and cured only by delivery
Aspirin if at risk, labetalol to treat
Eclampsia
Seizures as a result of preeclampsia
Magnesium sulphate can be used in severe disease, alongside labetalol
Steroids
PCOS
2+ from -ovaries polycystic morphology on ultrasound -irregular periods 5 or more weeks apart -hirsuitism Clomifene, metformin, uterine drilling
Premenopausal symptoms
Symptoms of the perimenopause or menopause despite still having regular menstruation
Pelvic inflammatory disease
Sexually transmitted pelvic infection
Multiparous, poor, sexually active risk factors
Analgesia and IM Ceftriaxone
Prolactinoma
Pituitary tumour
Causes menstruation disturbance in women and erectile dysfunction in men
Hypogonadism, infertility and osteoporosis
Carbergoline agonist
Surgery
Gestation DM
Altered carbohydrate metabolism, antagonistic effects of human placental hormone, progesterone and cortisol
Diet then metformin then insulin
Sexuality
Sexual orientation refers to a person’s physical, romantic and/or emotional attraction towards other people.
Lobe syndromes
Frontal- motor and personality
Parietal sound
Temporal smell
Occipital- vision
Endocrine causes of altered mental state
Hypoglycaemia
Thyroid disturbance
Adrenal insufficiency
DKA
Acute and transient psychosis
Less than 1 month
Schizoaffective disorder
Mood change to
Schiotypal disorder
Latent, family history, acting weird
Persistent delusional disorder
Single or set of delusions held for more than 3 months
Late paraphrenia
Late onset schizophrenia
Induced delusional disorder
Same delusions in more than one person
Mood stabilisers
Drugs used to prevent mania and depression in bipolar and schizoaffective disorders.
Valproate if not childbearing
Lithium if future adherence likely
(cabamazepine and lamotrigine also)
Lithium
Long QT, hypothyroid, renal disturbance and tremor. Polyuria and polydipsia. Teratogenic
Before starting: ECG, TFT, U and E, eGFR, pregnancy test
Weekly monitoring until stable for 4 weeks and then 3 monthly
(if far too high then lots of fluid and NaCl)
Valproate
Increased weight. Teratogenic, liver problems, polyphia
Before starting: BMI, pregnancy test, TFTs and PTT
Which drug for mood stabilising a woman of childbearing age
Lamotrigine
Still gets headache, rash, tremor
Endometrial polyps
40-50 when oestrogen levels are high
Menorrhagia and IMB
US
Resection with cutting diathermy
Abnormal formation of uterus
failure of fusion of mullerian ducts at 9 weeks. Unicornuate (half) uterus Fundal septum Vaginal septum - hysteroscopic resection
Prelabour rupture of membranes
After 37 weeks but before labour
Gush out of fluid. Avoid vaginal exam.
CTG and high vaginal swab
Antibiotics or immediate induction
Premature labour
TVUS of cervical length
Nifedipine can be used as a tocolytic to prevent contractions
Magnesium sulphate for neuroprotection
Constipation
Fluids, balanced diet, movicol then senna.
Hirschprungs, hypothyroid, coeliac or anus pathology
Appendicitis
Central and colicky, goes to right illiac fossa. Worse on movement, guarding and tenderness.
Ultrasound
Appendectomy
IBD
Crohns mouth to anus, enteral nutrition, beclamethasone then azathioprine
UC: blood diarrhoea, LLQ tenderness, toxic megacolon.
Beclamethasone and IV fluids then mesalazine
Coeliac
Gliadin enteropathy.
Small intestine biopsy (villous atrophy, interepithelial lymphocytes, crypt hyperplasia)
Tissue translgutaminase, endomysial antibodies
Gluten free diet
Intussuscpetion
Invagination of proximal bowel into distal segment. Redcurrent jelly stool. Sausage shaped mass.
Ultrasound
Tx rectal air insuffation or surgery
Hirschprungs
Absence of myenteric plexus
Delayed passage of meconium
Suction rectal biopsy
Nephritic syndrome
Post streptococcal
Oedema, hypertension, reduced urine output, haematuria, proteinuria
Fluid and electrolyte balance
Diuretics
Polycystic kidney disease
Autosomal recessive- diffuse bilateral enlargement of both kidneys. Many small cysts
Autosomal dominant- seperate cysts of varying size between normal renal parenchyma
Multicystic renal dysplasia
Kidney replaced by varying sized cysts. No normal renal parenchyma, ureter atresia
Name 3 types of renal malformation
Polycystic kidney disease
Multicystic renal dysplasia
Potter syndrome
Vesicoureteric reflux
Developmental anomaly of vesicoureteric junction
MAG3 or MCUG scan
more uti, pyelonephritis and renal damage
Treat with bulking injections or surgery
Haemolytic uraemic syndrome
1) Acute renal failure
2) haemolytic anaemia
3) thombocytopenia
From EColi GI infection
Treat with dialysis
Measles
Viral. Koplik spots (white spots on inside of cheeks), malaise, maculopapular rash
Encephalitis
Vitamin A can be given as worse complications in malnourished or immunocompromised
